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This is the final version of the article. Available from BioMed Central via the DOI in this record.

Abstract

Many older people have chronic knee pain. Both topical and oral non- steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat this. Oral NSAIDS are effective, at least in the short term, but can have severe adverse effects. Topical NSAIDs also appear to be effective, at least in the short term. One might expect topical NSAIDs both to be less effective and to have fewer adverse effects than oral NSAIDs. If topical NSAIDs have fewer adverse effects this may outweigh both the reduction in effectiveness and the higher cost of topical compared to oral treatment. Patient preferences may influence the comparative effectiveness of drugs delivered via different routes.

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The research costs for this study have been provided by the NHS Health Technology Assessment Programme. NHS R&D have provided NHS excess treatment and service support costs. We are grateful to Goldshield Pharmaceuticals for starter packs of topical ibuprofen. We are grateful to Helen Tate for statistical advice on study design and to Miranda Mugford for advice on health economic analysis. TOIB is a collaborative project between the Centre for Health Sciences at Barts and The London and the Medical Research Council General Practice Research Framework. We would like to acknowledge the contributions made by the funding applicants (Ashby D, Feder G, Harding G, Martin J, Parsons S, Spencer A, Underwood M (PI), Vickers M), the study team (Cross P, Hennessy E, Letley L, Shah H, Underwood M, Whyte K), the Trial Steering Committee (Ashby D, Buszewicz M, Carr A, Cross P, Grimley-Evans J, Hay E. Hennessey E, Lemon S, Letley L, Little P, Martin J, Shah H, Shine U, Underwood M, Vickers M, Whyte K), and the Data Monitoring and Ethics Committee (Adebajo A, Hennessey E, Morris R, Smeeth L). We would also like to thank the GPRF lead GPs, nurses and regional trainers involved in the TOIB study.